NEURORADIOLOGY Spine and spinal cord Erika Vörös University of Szeged Department of Radiology SZEGED
DISEASES OF SPINE AND SPINAL CORD I. Non-tumourous diseases developmental anomalies vascular disorders inflammatory processes degenerative changes trauma II. Tumours extradural intradural - extramedullary intramedullary
SPINE AND SPINAL CORD - imaging methods Plain film radiography Ultrasonography Computer tomography (CT) Magnetic resonance imaging (MRI) Digital subtraction angiography (DSA) Myelography
Imaging modalities - indications Plain film radiography developmental anomalies: bone inflammations: spondylitis / spondylodiscitis degenerative: spondylarthrosis trauma: fractures / dislocations tumours: bone changes
Imaging modalities - indications Computer tomography (CT) developmental anomalies: bones / spinal canal inflammations: bones / discs degenerative changes: spondylarthrosis, disc herniations trauma: bones, epi - subdural haemorrhages tumours: bone changes Myelo-CT trauma: dural and radicular injuries etc.
Imaging modalities - indications Magnetic resonance imaging (MRI) spinal cord lesions: all! developmental anomalies vascular disorders inflammatory processes degenerative diseases: disc herniations trauma: intramedullary lesions, haemorrhages tumours
Imaging modalities - indications Digital subtraction angiography (DSA) preoperative dg, diff.dg vascular malformations hypervascularized tumours intervention (embolization) vascular malformations hypervascularised tumours
Imaging modalities - indications Myelography if MRI not available: degenerative diseases, spaceoccupying lesions, trauma etc. severe scoliosis arachnoiditis
DEVELOPMENTAL ANOMALIES: (some injury in fetal life) Stage 1: Weeks 3-4 Dorsal Induction: Formation and Closure of the Neural Tube Three phases: Neurulation, canalization, retrogressive differentiation Failure: Anencephaly, Cephalocele, Chiari, Spinal dysraphism Stage 2: Weeks 5-10 Ventral Induction: Formation of the Brain Segments and Face Three vesicles (prosencephalon, mesencephalon, and rhombencephalon) form the cerebrum, mid-brain, cerebellum, and lower brain stem. Division into two hemispheres. Failure: Holoprosencephalies, Corpus callosum agenesis, Dandy Walker,Facial anomalies Stage 3: Months 2-5. Migration and Histogenesis Neuronal migration from germinal matrix to the cortex. Cortical organization. Disorders: Heterotopias, agyria-pachygyria, polymicrogyria, vascular malformations, teratomas, phakomatosis. Stage 4: 5-15 months; matures by 3 years. Myelination Inferior to superior; posterior to anterior. Failure: developmental delay, dysmyelinating disease
Developmental anomalies Generally complex (several layers and several levels involved) bones meninges spinal cord Chiari malformation, Tethered cord, syringomyelia spina bifida
Developmental anomalies Generally complex (several layers and several levels involved) bones meninges spinal cord Diastematomyelia with block vertebrae
Vascular disorders Developmental malformations Acquired infarcts Spinal arterio-venous fistula
Vascular disorders Malformations Therapy planning Spinal dural arterio-venous fistula
Vascular disorders Developmental malformations Acquired (stenoocclusive, thromboembolic) infarcts Ischaemic infarct
Inflammatory processes Spondylitis/spondylodiscitis Meningitis Myelitis Multiple sclerosis
Gyulladásos folyamatok Spondylitis/spondylodiscitis Meningitis/arachnoiditis Myelitis Sclerosis multiplex
Inflammatory processes Spondylitis/spondylodiscitis Meningitis Myelitis/radiculitis Guillain-Barré syndrome Multiple sclerosis
Inflammatory processes Spondylitis/spondylodiscitis Meningitis Myelitis Multiple sclerosis
Inflammatory processes Spondylitis/spondylodiscitis Meningitis Myelitis Multiple sclerosis
Degenerative changes Spondylarthrosis Disc herniations
Degenerative changes Spondylarthrosis synovial cyst Disc hernia
Degenerative changes Spondylarthrosis Disc herniations CT MR myelography
Degenerative changes Spondylarthrosis Disc herniations CT MR myelography
Degenerative changes Spondylarthrosis Disc herniations - locations medial paramedial lateral (foraminal and extraforaminal)
Degenerative changes Spondylarthrosis Disc herniations postoperative scar
Degenerative changes Spondylarthrosis Discus hernia postoperative scar recurrent/residual DH Preop. Postop.
Traumatic lesions Fractures/dislocations Haemorrhages Spinal cord injuries Dural tear/root avulsion
Traumatic lesions Fractures/dislocations Haemorrhages Spinal cord injuries Dural tear/root avulsion
Traumatic lesions Fractures/dislocations Haemorrhages Spinal cord injuries Dural tear/root avulsion
Traumás eltérések Törések / luxatiók Haemorrhagiák Gerincvelő/dura sérülések Cord herniation Dura/ gyöksérülés
Traumatic lesions Fractures/dislocations Haemorrhages Spinal cord injuries Dural tear/root avulsion
Tumours Extradural Bone metastasis Intradural - extramedullary meningiomas neurinomas Intramedullary astrocytomas ependymomas haemangioblastomas T2W T1W FLAIR
Tumours Extradural Other bone tumours Intradural - extramedullary meningiomas neurinomas Intramedullary astrocytomas ependymomas haemangioblastomas Myeloma
Tumours Extradural Intradural - extramedullary meningeoma neurinoma Intramedullary astrocytoma ependymoma haemangioblastoma Meningioma causing cord compression
Tumours Extradural bone tumours metastases Intradural - extramedullary meningiomas neurinomas Intramedullary astrocytomas ependymomas haemangioblastomas Dumbbell-shaped tumour
Tumours Extradural bone tumours metastases Intradural - extramedullary meningiomas neurinomas Intramedullary astrocytomas ependymomas haemangioblastomas Cystic intramedullary tumour
Tumours Extradural bone tumours metastases Intradural - extramedullary meningiomas neurinomas Intramedullary astrocytomas ependymomas haemangioblastomas Intramedullary tumour + syringohydromyelia